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SUICIDE ASSESSMENT: JOANNE
Presenting Problem
Joanne presents with an acute emergent risk for suicide—where suicide is imminent--
based on the “I.S.P.A.T.H.W.A.R.M.” suicide risk assessment. (Jackson-Cherry & Erford, 2017,
p. 160; Substance Abuse and Mental Health Services Administration (SAMHA), 2023, p. 20-21).
This is due to her arriving at the counseling center unannounced, saying a symbolic goodbye,
declaring that she has a loaded firearm in her vehicle, and knowing her previous history of
suicidal ideation, behavior, and plans (SAMHS, 2023, p. 10, 20; Jackson-Cherry & Erford, 2017,
p. 157). When questioned about her motives, she deflects all conversation; stating that she only
wishes to go for a drive.
Precipitating Event
Ten years ago, Joanne and her husband were divorced after he came out as a homosexual.
Three years after the divorce, she began an affair with her sister’s husband. She ended the
relationship after a year, but her brother-in-law still pushes for the relationship to resume. Her
sister has no idea (to her knowledge) of the affair. In addition, for an undisclosed amount of time,
she has been struggling with chronic depression, suicidal ideation (SI), and three suicide attempts
(SA). She has not regularly taken the prescribed medication from her psychiatrist (Omar, 2021).
Risk Factors
Depression and divorce—for a woman under 50—puts her at a higher risk for SI and SA
(Omar, 2021, p. 323)
She is in possession of a firearm (SAMHSA, 2023, p. 21)
Current SI, past SI, and past SA (SAMHSA, 2023, p. 21)
Stressful life circumstances of not only the divorce, but also the hidden affair and guilt
that comes with it (SAMHSA, 2023, p. 21)
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SUICIDE ASSESSMENT: JOANNE
Low social support, as the person she wants to distance herself from is where her biggest
support would be (SAMHSA, 2023, p. 21).
Conflicted relationship with sister and brother-in-law (SAMHSA, 2023, p. 21).
Possession of a firearm (SAMHSA, 2023, p. 21).
Sudden mood change (SAMHSA, 2023, p. 21; Jackson-Cherry & Erford, 2017, p. 158)
The Covid-19 Epidemic creating more isolation in recent years (Górski, Buczkowska,
Grajek, Garbicz, Całyniuk, Paciorek, Głuszek, & Polaniak, 2022).
Resources and Protective Factors
Current Protective Factors
Although a source of high stress, Joanne does have a stable job (SAMHSA, 2023, p. 24).
At this job are her coworkers that could probably be a source of personal support for her now
(and in the future). Another facet of personal support is her 13-year-old daughter, and (although
the relationship is strained) her sister (SAMHSA, 2023, p. 24). However, the heavier emphasis
should be on her daughter; not only is she a child, but she is probably the largest source for
Joanne’s will to live (SAMHSA, 2023, p. 24).
In her community, there are plenty of 12-step programs that she can be a part of, for those
struggling with SI and SA (SAMHSA, 2023, p. 24). There are also groups—online and in-person
—who have been through a difficult divorce (SAMHSA, 2023, p. 24). For the immediate time
being, Joanne may find a group home to be helpful, especially one that will give her daily
supervision, therapy, and medication, until she is deemed to not be a harm to herself (Górski, et
al., 2022).
Future Protective Factors
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SUICIDE ASSESSMENT: JOANNE
Finding a therapist who specializes in mixed-orientation relationships would be beneficial
to Joanne, to help her through her specified grieving process and cognitive dysfunctions
(American Psychological Association (APA), 2013). additionally, reading psychoeducational
materials on the topic of having a spouse come out as a homosexual would be beneficial as well
(APA), 2013). Secondly, there is an organization called “Our Path” who can help Joanne find
individuals in the local, national, and global scale who have been in the same situation as her
(Our Path, 2023).
Spirituality
Ethical Considerations
The first ethical consideration should be nonmaleficence, as the ultimate goal of a
therapist is to “do no harm” to the client (American Counseling Association (ACA), 2014, p. 3;
American Association of Christian Counselors (AACC), 2014, p. 13). Secondly, ethical
guidelines state that a counselor should be knowledgeable about referrals that would clinically be
beneficial to the client (ACA, 2014, p. 6). This includes knowing when to seek supervision
and/or referral for immediate treatment in cases where the client is an active danger to
themselves (or others) (Jackson-Cherry & Erford, 2017, p. 26; AACC, 2014, p. 19).
Spiritual Considerations
Spirituality can either be a protective factor or a risk factor (Jackson-Cherry & Erford,
2017, p. 154). This all comes down to whether the spiritual teachings, practices, or community
see the individual suffer with SI or SA as a failure or someone who needs help (Jackson-Cherry
& Erford, 2017, p. 154). A recent study confirms this perspective, and those from around the
world either connected their spirituality as the cause for SI or SA, or it was the buffer that
allowed them to feel hope and purpose (Stefa-Missagli, Unterrainer, Giupponi, Wallner-
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SUICIDE ASSESSMENT: JOANNE
Liebmann, Kapfhammer, Conca, Sarlo, Berardelli, Sarubbi, Andriessen, Krysinska, Erbuto,
Moujaes-Droescher, Lester, Davok, & Pompili, 2020, p. 548). However, it has been shown that
spirituality increases the chances of avoiding SA and SI, when existential well-being is used as a
protective factor (Stefa0Missagli, et al., 2020, p. 548).
Interventions
Ask for immediate supervision with her psychiatrist, and a supervisor/colleague in the
building, as she has direct warning signs (SAMHSA, 2023, p. 28, 38)
Screen her to the best of my ability, to try and get as much information as possible
(SAMHSA, 2023, p. 31)
If possible, attempt to collaborate with client to arrange hospital transportation
(SAMHSA, 2023, p. 44)
If patient is noncompliant, call the police. As she has a firearm, chasing her to her car
would not be safe for myself or the staff in the building (Jackson-Cherry, 2017, p. 162)
Once client is met by police, and no longer on the premises, immediately document
everything that happen, and every step taken for legal and clinical purposes (SAMHSA,
2023, p. 38)
Treatment Plan: Goals and Interventions
Sample Problem 1 (mental): Joanne’s problem-solving skills have reduced her ability to
combat feelings associated with chronic depression, SI, and SA (Berghuis & Klott, 2015, p. 86).
Goal 1: Joanne will address and reduce feelings of worthlessness, hopelessness, and SI as
they arise.
Objective 1: Joanne will be able to know what coping mechanisms have worked
for her in the past, and which ones did not. She will then lean into the ones that have worked and
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SUICIDE ASSESSMENT: JOANNE
learn 2 new ones as well with the goal of decreasing depressive symptoms, and SI and SA
severity.
Intervention 1: Therapist/Counselor will collaborate on writing out
autobiography of her crisis situations and positive and negative problem-solving strategies that
were developed or implemented during that time (Berghuis & Klott, 2015, p. 86). Therapist will
help assist in reframing positive coping strategies from her autobiography and implement 2 new
ones in the hope to reduce severity of symptoms—to where it does not meet crisis criteria
(Berghuis & Klott, 2015, p. 86).
Sample Problem 2 (physical): Joanne’s neurological functions are dysregulated, as she does not
regularly take her prescribed medications from her psychiatrist (Berghuis & Klott, 2015, p. 285).
Goal 1: Joanne will begin to see psychiatric symptom improvement by taking her
medication regularly (Berghuis & Klott, 2015, p. 285).
Objective 1: Joanne will regularly take her medication, no matter the
circumstances of the day or emotional status (Berghuis & Klott, 2015, p. 285).
Intervention 1: Educate the client (along with her psychiatrist) about the
reasoning behind the chosen medication and have her feel she can make an informed decision on
what her options are by processing it with both providers (Berghuis & Klott, 2015, p. 285).
Sample Problem 3 (social): Joanne has little to no social support, which is a high-risk factor for
her struggle with SI and SA (Berghuis & Klott, 2015, p. 35, 87; Donovan, N. J., & Blazer, 2020).
Goal 1: Joanne will be able to connect with others, especially if she is experiencing her
depressive and SI symptoms (Berghuis & Klott, 2015, p. 87).
Objective 1: Joanne will make form relationships with others, and be able to have
a list of those she can trust when she is having a crisis (Donovan & Blazer, 2020, p. 13)
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SUICIDE ASSESSMENT: JOANNE
Intervention 1: Therapist will help Joanne find a SI and SA therapy
group to join (Donovan, N. J., & Blazer, p.13, 87). Therapist/Counselor and Joanne will
collaborate on a contact sheet, where Joanne will make a list trusted family, friends, suicide
hotlines, and community suicide centers that she can call in case of a crisis (Berghuis & Klott,
2015, p. 35).
Sample Problem 4 (emotional): Joanne keeps falling back into a place of hopelessness, which
is linked to a low self-image and lack of confidence.
Goal 1: Joanne will be able to acknowledge her progress and be proud of herself
(Berghuis & Klott, 2015, p. 87)
Objective 1: Joanne will gain confidence and pride by tracking her progress in
and out of psychotherapeutic sessions.
Intervention 1: Joanne will journal daily to describe her feelings,
thoughts, and what coping strategies were used (if any). She will then review journal entries with
therapist to ingrain and assess progress (Berghuis & Klott, 2015, p. 87).
Sample Problem 5: Joanne needs to find purpose in her life to reduce SI and SA symptoms.
Goal 1: Joanne will increase her spiritual well-being (Berghuis & Klott, 2015, p. 114).
Objective 1: Joanne will seek out any or all desired spiritual interests and/or
needs that she can draw from to gain purpose for her life (Rasic, Robinson, Bolton, Bienvenu, &
Sareen, 2011).
Intervention: Therapist will discuss any religious or spiritual preference
with Joanne, and help her locate places of worship, groups, and/or resources for that preference
(Rasic, et al. 2011;Berghuis & Klott, 2015, p. 114).
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SUICIDE ASSESSMENT: JOANNE
References
American Association of Christian Counselors. (2014). Y-2014 code of ethics.
https://www.aacc.net/wp-content/uploads/2020/06/AACC-Code-of-Ethics-Master-
Document.pdf
American Counseling Association. (2014). 2014 ACA code of ethics.
https://www.counseling.org/docs/default-source/default-document-library/2014-code-of-
ethics-finaladdress.pdf
American Psychological Association. (2013). Helping the straight spouse when a wife or
husband comes out as lgb or t. https://www.apa.org/pi/lgbt/resources/helping-straight-
spouse.
Berghuis, D. J., & Klott, J. (2015). The suicide and homicide risk assessment and prevention
treatment planner, with dsm-5 updates. John Wiley & Sons, Incorporated.
Donovan, N. J., & Blazer, D. (2020). Social isolation and loneliness in older adults: review and
commentary of a national academies report. The American Journal of Geriatric
Psychiatry: Official Journal Of The American Association For Geriatric Psychiatry,
28(12), 1233–1244. https://doi.org/10.1016/j.jagp.2020.08.005
Górski, M., Buczkowska, M., Grajek, M., Garbicz, J., Całyniuk, B., Paciorek, K., Głuszek, A., &
Polaniak, R. (2022). Assessment of the risk of depression in residents staying at long-term
care institutions in poland during the COVID-19 pandemic depending on the quality of
cognitive functioning. Frontiers in Psychology, 12, 766675-766675.
https://doi.org/10.3389/fpsyg.2021.766675
Jackson-Cherry, L., & Erford, B. T. (2017). Crisis assessment, intervention, and prevention (3rd
ed.). Pearson Education (US). https://mbsdirect.vitalsource.com/books/9780134523491
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SUICIDE ASSESSMENT: JOANNE
Omary, A. (2021). Predictors and confounders of suicidal ideation and suicide attempts among
adults with and without depression. The Psychiatric Quarterly, 92(1), 331–345.
https://doi-org.ezproxy.liberty.edu/10.1007/s11126-020-09800-y
Our Path. (2023). Find support. https://ourpath.org/find-support/
Rasic, Robinson, J. A., Bolton, J., Bienvenu, O. J., & Sareen, J. (2011). Longitudinal
relationships of religious worship attendance and spirituality with major depression,
anxiety disorders, and suicidal ideation and attempts: findings from the baltimore
epidemiologic catchment area study. Journal of Psychiatric Research., 45(6), 848–854.
https://doi.org/10.1016/j.jpsychires.2010.11.014
Stefa-Missagli, S., Unterrainer, H., Giupponi, G., Wallner-Liebmann, S., Kapfhammer, H.,
Conca, A., Sarlo, M., Berardelli, I., Sarubbi, S., Andriessen, K., Krysinska, K., Erbuto,
D., Moujaes-Droescher, H., Lester, D., Davok, K., & Pompili, M. (2020). Influence of
spiritual dimensions on suicide risk: the role of regional differences. Archives of Suicide
Research, 24(4), 534-553. https://doi.org/10.1080/13811118.2019.1639571
Substance Abuse and Mental Health Services Administration (SAMHS). (2023). Quick guide for
clinicians based on tip 50. SAMHSA.gov. Retrieved February 1, 2023, from
https://store.samhsa.gov/sites/default/files/d7/priv/sma13-4793.pdf
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